Some people have been able to identify certain foods or drink that seem to trigger their headaches, and by carefully watching their diets they’ve been able to reduce their headache frequency. For our first meeting of the new century, the East Bay Headache Support Group has invited Beverly Briar, a registered dietitian at John Muir Medical Center, to speak on the topic of food triggers for headaches.

We will meet in the Ball Auditorium at John Muir Medical Center on Tuesday, January 11th, from 7:30 to 9:00 pm. Call (925) 938-5252 for more information.

Results of early trials for several new migraine prevention drugs were reported at the 41st Annual Scientific Meeting of the American Association for the Study of Headache (AASH). The treatments being studied are botulinum toxin (Botox); gabapentin (an anti-seizure drug similar to divalproex sodium, or Depakote); dotarizine, a serotonin-2 antagonist; and montelukast, an asthma drug that blocks an inflammatory substance known as leukotriene. Botulinum toxin, gabapentin and dotarizine were all reported to be more effective than placebo in blinded trials involving 120 to 300 patients. The small preliminary study of the leukotriene antagonist reported excellent results in 10 of 14 patients, but larger blinded studies will be needed to demonstrate its efficacy. Further studies of these and other new preventive drugs offer hope to people with very frequent or severe headaches that are not adequately controlled by drugs such as the triptans and DHE.

Migraine patients appear to have a "hyperexcitable" visual cortex (the part of the brain that processes visual images) that may explain why many patients can have attacks triggered by flickering lights. A study reported at the 41st Annual Scientific Meeting of AASH compared responses to magnetic stimulation of the visual cortex in migraine patients and normal volunteers. The migraine patients were much more likely to report seeing glowing or shimmering spots in response to the stimulation. About half of the migraine patients reported getting a headache, while none of the control group experienced a headache in response to the stimulation.

In addition to well-known methods of warding off headaches (i.e., managing stress, getting adequate sleep and avoiding triggering factors if you suffer from migraines), there are simple neck and shoulder exercises that have been shown to be effective in reducing the incidence of headache attacks.

This article will explain why these exercises—which may take just 15-20 minutes to do—are so effective, and will explain how some of them are done.

Muscle tension can be a big contributor to headaches. Here’s why:

Stress and poor posture can create tension and muscle strain in your neck, shoulders and upper back. This alone may trigger a headache.

When you have a headache, your muscles tense up even further because your natural instinct is not to move your head. (If you do, it hurts more.) If you’re a frequent head-ache sufferer, over time your muscles may become shortened, chronically fatigued and even irritated. This increases the likelihood that you will continue to get headaches! As you can imagine, this can easily become a self-perpetuating situation.

Gentle neck and shoulder exercises may be used to relax and stretch strained, shortened muscles. This can reduce tension and decrease the risk of headaches triggered by muscle irritation. For some people, strengthening exercises are also recommended.

Here are some basic exercises recommended by headache experts. These are effective for both tension headache and migraine sufferers alike.

Neck rotation. Keeping your head level, slowly turn it until you are looking straight out over one shoulder. Hold this position for 1-2 seconds, then look down at the shoulder. Return your head to center, then repeat in the the other direction. For greater stretch, remain in each position for 10-20 seconds.

Neck retraction. Squeeze your shoulder blades together. Then pull your head straight back, making sure to keep it level. Hold this position for 5-10 seconds, then relax. Repeat 10 times.

Chinning. Starting with your head level and looking straight ahead, inhale and tuck in your chin. Then exhale and stick out your chin. Repeat 3-5 times. This exercise helps your head stay in the proper position on your neck.

Shoulder shrugs. Relax your arms at your side, then lift your shoulders to your ears. Squeezing your shoulder blades together, rotate your shoulders to the back and then down. Repeat 10 times. Note: Never rotate your shoulders forward.

Shoulder retraction. Touch your fingers to your ears and raise your elbows slightly. Making sure not to push or pull on the neck, squeeze your shoulder blades together. Hold for 5 seconds, then release.

Upper back stretch. With arms extended in front of your body, clasp your hands together. Pull your shoulder blades apart gently, then drop your chin to your chest. Hold this position for 10-30 seconds.

Trapezius stretch. Turn your head 45 degrees to the right. Reach over the top of your head with your right hand and cradle the back of your head with your fingers. Gently pull your head toward your right shoulder, and hold for a count of 20. Repeat on the left side using your left hand.

For best results, be sure to breathe deeply and stretch slowly and gently...do not push! And if you have any neck, shoulder or back injuries, be sure to consult your doctor before trying these exercises.

If you would like more in-depth information about neck and shoulder exercises, or if you feel you would benefit from a customized exercise routine, ask your doctor for a referral to a registered physical therapist who has expertise in treating headache patients. A physical therapist can evaluate and educate you about your specific condition, select the appropriate exercises, demonstrate them for you, and design an exercise program that you can do at home or at work. Usually this is preceded by in-office treatment.

The Biofeedback Loop. A biofeedback instrument acts as a kind of "sixth sense," allowing you to "see" or "hear" bodily changes that may contribute to headaches. For example, sensors on the forehead detect and amplify muscle tension, and convert it to a light or an audible tone whose intensity is fed back through your eyes and ears.

How biofeedback helps control headache. Biofeedback can help you become aware of, and then modify, biological processes that are associated with migraine and tension type head-aches. Both uneven blood flow and muscle contraction are processes that are usually involuntary and contribute to headache pain. Using biofeedback techniques, you can learn to put your nervous system into a state of deep relaxation. In this state, your muscles

are loose and blood flows in a stable, even way to all parts of your body— the opposite of what happens during headaches.

Your goal: change your body’s habitual reaction to stress. Training your body to achieve an anti-headache state of deep relaxation will involve multiple sessions with a professional biofeedback therapist, usually a psychologist. During these sessions, relaxation may be measured one of three ways:

An electromyograph (EMG) measures the amount of electrical energy generated by muscles in your forehead, and will likely be used if you suffer from muscle contraction or tension headaches.

A finger thermometer measures blood blow through your fingers, and is often used for those with migraine headaches. Blood vessels in the fingers are very sensitive to stress (vessels constrict) and relaxation (vessels dilate; temperature rises).

An electroencephalograph (EEG) monitors the type of energy (brain waves) generated by your brain. Your biofeedback therapist will give you or tell you how to obtain a portable measuring device to use at home (usually an EMG or a finger thermometer). For best results, you will need to practice biofeedback/relaxation techniques often at home and may need some "booster" sessions with your biofeedback therapist as time goes on.